The nhs is caught in a 'gridlock' of forces that make change ex- ceedingly difficult to bring about. Public policy should seek to cre- ate an environment for the nhs that is hospitable to quality- impro- ving and efficiency-improving change. Opportunities for constructive change should be nurtured, not politicized or otherwise abused. The nhs runs on the ability and dedication of the many people who work in it. But its structure contains no serious incentives to guide the nhs in the direction of better quality care and service at reduced cost. In fact, the strucutre of the nhs contains perverse incentives. The nhs could benefit from making much greater use of demonstration pro- jects.
This book provides a significant contribution to the discussions about the future of the system.The evidence-driven content draws from the deep expertise and experience of a wide spectrum of contributors, who represent virtually all relevant areas of the health system.
The foundation of the National Health Service on 5 July 1948 was a momentous development in the history of the United Kingdom. Issues of health care touch the lives of everyone, and the NHS has come to be regarded as the cornerstone of the welfare state and as a model for state-organisedhealth care systems elsewhere. Yet throughout its history, the Service has existed in an atmosphere of crisis. Charles Webster's political history is an entirely new and original examination of the NHS from its inception through to its management under the first term of the current Labourgovernment, providing the necessary framewrork for assessing its future as we enter the new millennium.
This book contrasts the proposals of the Royal Commission of the late 1970s with the very different set of priorities enshrined in the 1989 White Paper and describes how the changes between the two documents came about. It argues that the NHS reforms should be seen not as the inevitable product of technical developments nor as a consensus response to narrowly managerial difficulties within the NHS, but rather as part of a wider political strategy towards state provision of welfare. The book strongly emphasises the uneven geographical impacts of post-1979 changes, a topic usually underplayed by analysts of social policy, and draws heavily on previously unpublished material.
The origins of the NHS are the subject of this study that presents evidence on the key players who participated in the founding of the system. The author also traces those who opposed the NHS.
The NHS came into existence in an atmosphere of conflict centred on the strong ideological commitment of the Post-war Labour Government and the opposition of the Conservative Party of that time to the idea of a universally available and centrally planned medical care service. There was also opposition from some sections of the medical establishment who feared the loss of professional autonomy. Setting health policy in both an historical and modern context (post 1997) Carrier and Kendall weigh up the successes and failures of the National Health Service and examine the conflicts which have continued for over sixty years, in spite of efforts to solve financial problems in the NHS through increases in funding as well as structural and organisational change. After looking at recent responses to supposed failures of the NHS, they conclude that the NHS has successfully faced the challenges before it and is likely to continue to meet the changing health needs of the population. Financial stresses, concerns about the quality of care and demographic change, with consequent issues for the elderly and the chronically ill, continue to be urgent and politically contentious issues. This book is appropriate for a wide range of undergraduate and postgraduate students studying health policy and the NHS.
This reader offers instant access to fifty classic and original readings in health policy and management. Compiled by experts, the editors introduce a framework setting out the key policy drivers and policy levers, giving a conceptual framework that provides context for each piece.
The anthrax incidents following the 9/11 terrorist attacks put the spotlight on the nation's public health agencies, placing it under an unprecedented scrutiny that added new dimensions to the complex issues considered in this report. The Future of the Public's Health in the 21st Century reaffirms the vision of Healthy People 2010, and outlines a systems approach to assuring the nation's health in practice, research, and policy. This approach focuses on joining the unique resources and perspectives of diverse sectors and entities and challenges these groups to work in a concerted, strategic way to promote and protect the public's health. Focusing on diverse partnerships as the framework for public health, the book discusses: The need for a shift from an individual to a population-based approach in practice, research, policy, and community engagement. The status of the governmental public health infrastructure and what needs to be improved, including its interface with the health care delivery system. The roles nongovernment actors, such as academia, business, local communities and the media can play in creating a healthy nation. Providing an accessible analysis, this book will be important to public health policy-makers and practitioners, business and community leaders, health advocates, educators and journalists.
Getting the right diagnosis is a key aspect of health care - it provides an explanation of a patient's health problem and informs subsequent health care decisions. The diagnostic process is a complex, collaborative activity that involves clinical reasoning and information gathering to determine a patient's health problem. According to Improving Diagnosis in Health Care, diagnostic errors-inaccurate or delayed diagnoses-persist throughout all settings of care and continue to harm an unacceptable number of patients. It is likely that most people will experience at least one diagnostic error in their lifetime, sometimes with devastating consequences. Diagnostic errors may cause harm to patients by preventing or delaying appropriate treatment, providing unnecessary or harmful treatment, or resulting in psychological or financial repercussions. The committee concluded that improving the diagnostic process is not only possible, but also represents a moral, professional, and public health imperative. Improving Diagnosis in Health Care, a continuation of the landmark Institute of Medicine reports To Err Is Human (2000) and Crossing the Quality Chasm (2001), finds that diagnosis-and, in particular, the occurrence of diagnostic errorsâ€"has been largely unappreciated in efforts to improve the quality and safety of health care. Without a dedicated focus on improving diagnosis, diagnostic errors will likely worsen as the delivery of health care and the diagnostic process continue to increase in complexity. Just as the diagnostic process is a collaborative activity, improving diagnosis will require collaboration and a widespread commitment to change among health care professionals, health care organizations, patients and their families, researchers, and policy makers. The recommendations of Improving Diagnosis in Health Care contribute to the growing momentum for change in this crucial area of health care quality and safety.
